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MRCOG part 1 > Recalls 10 > Flashcards

Recalls 10 Flashcards

1
Q

Label this

A
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2
Q

What is this. Label the bits

A
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3
Q

What is the criteria for a normal semen report

A
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4
Q

What is it called when uss waves have a decreased amplitude due to scattering, absorption or reflection

A

Attenuation artifact

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5
Q

What is the MOA of Mirabegron

A

Selective B3 agonist

Think agonist because B agonsits in lungs cause relaxation of muscles

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6
Q

How to work out BMI

A

weight kg / height m SQUARED

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7
Q

How to work out the maternal mortality ratio

A

deaths/total x 100,000

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8
Q

RECEPTORS
What type of receptor is oestrogen/progesterone
oxytocin

A

Nuclear transciption factor
G coupled protein receptor

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9
Q

Where are schiller duval bodies found

A

Endodermal sinus tumour

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10
Q

What is this

A

Mycoplasma genitalium

Flask shaped and do not have a cell wall

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11
Q

What type of bacteria is chlamydia

A

Gram negative
Obligate
Cocco-bacillus

PINK IS NEGATIVE

pink makes the boys wink - STIs

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12
Q

What type of haemolysis do Group A and group B strep do

A

B haemolytic

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13
Q

What links the innate and adaptive immune systems

A

Cytokines

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14
Q

What type of prostaglandin is carboprost

A

Prostaglandin F2a

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15
Q

How manh mitochondrial DNA genes are there

A

37

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16
Q

Nevirapine MOA

A

Non-competitive reverse transcriptase inhibitor

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17
Q

What is the craic with HRT and breast Ca

A

Combined HRT slightly increases risk of breast Ca

If you have had a hysterectomy and can take oestrogen only, there is no increased risk of breast Ca.

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18
Q

VZV immunity levels

A

if >1.1 then immune
if <0.8 then not immune

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19
Q

Label the conditions

A
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20
Q

How does cardiac output change in labour

A

First stage - increases 15%
Second stage - increases 50%

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21
Q

How much fetal cardiac output goes to the kidneys

A

2-3% as compared to 20% in the adult

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22
Q

What effect does HRT have on the thyroid system

A

Increases thyroid binding globulin. TBG is what carries T3 and T4

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23
Q

What types of toxins do staph and strep produce

A

Staph - exo and enterotoxins

Strep - exotoxin

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24
Q

Label these

A
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25
Q

Label the branches

A
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26
Q

What does phenylalanine get converted to

A

Tyrosine

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27
Q

Describe the relationship of the pelvic diaphragm to the perineal spaces

A
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28
Q

Extra calories required in 1/2/3 trimester

A

NONE in first

2nd 340

3rd 450

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29
Q

What happens to GH in cushing’s disease

A

Goes down due to excess cortisol

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30
Q

What are the timings of the emergency contraeptives

A

Levonorgestrel up to 72h (3 days)

Ullipristal acetate up to 120h (5 days)

Copper IUS up to 120h (5 days)

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31
Q

Which drug given in third trimester causes haemolytic anaemia

A

Nitrofurantoin

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32
Q

IVF cut off for BMI

A

Must be <30

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33
Q

What is the blood supply to the round ligament

A

Sampson’s artery

This is a branch of the inferior epigastric artery

34
Q

Actions of vitamin C

A

Collagen production

binds to iron
Promotes hydroxylation in protein synthesis

35
Q

How many adults in UK have normal BMI

A

36%

36
Q

When does urine become main contributer to amniotic fluid

A

18-20 weeks

37
Q

What are the following placenta abnirmalities:

Succenturiate lobe
Circumvallate
Velamentous

A

Succenturiate lobe - separate lobe
Circumvallate - membranes fold back on themselves to create dome shape
Velamentous insertion of cord - cord inserts into the membranes rather than the placenta

38
Q

ENDOMETRIOSIS

How is it diagnosed?
What are the treatment options? How do these work?
Surgical options?

Pregnancy considerations?

A

Diagnosis:
- Formally a tissue diagnosis
- Lap on longer gold standard.
- Only perform lap if imaging negative and symptoms remains despite hormoneal treatment

Treatment:
- COCP
- Mirena
- GNRH agonists and antagonists - second line
- Aromotase inhibitors

GNRH agonsits work by initially causing a flare of LH and FSH but then continued use causes desensitisation of the GnRH receptors - ultimately causing a menopause-like state
- Will need small dose oestrogen/progesterone HRT to protect bones

GNRH antagonists work by blocking the GnRH receptors. These can have dose titration and can therefore have fewer side effects than agonists.

Surgical options:
- Cystectomy for endometrioma
- Endometrial lesion removal - deep lesions to be referred to specialist centre
- Hysterectomy

Pregnancy considerations:
- Increased risk of miscarriage and ectopic in first trimester

39
Q

What is the lateral limit for PLND

What about:
Inferior
Caudal
Superior
Suoeriolateral

A

Lateral - Obliterated umbilical artery

Inferior - obturator nerve

Caudal - circumflex iliac

Superior - bifurcation of iliacs

Superiolateral - GF nerve

40
Q

What is the rate limiting step in the urea cycle

A

Enzyme = carbomoyle phosphatase synthetase

Requires NAG - N acetyl phosphatase

41
Q

How long does it take from the resting follicle to ovulation on average

A

300 days

42
Q

How do the various hormones contribut to milk production

A

Prolactin - alveolar and mammory development

HPL - mammory gland development

Oestrogen - ductal development. Inhibits secretory properties of prolactin until placenta delivered

Progesterone - alveolar development. Inhibits secretory properties of prolactin until placenta delivered

AFTER BIRTH:

Oxytocin - ejection of milk, caused by contraction
Prolactin - production of milk

43
Q

What is the most chromosomal common cause of primary ovarian failure

A

45 XO
1:2500

44
Q

Renal agenesis, oligohydrmanios, low set ears, limb problems

A

Potter syndrome

45
Q

Microcephaly, polydactylyl heart defects, omephalocele, polycystic kidneys

A

Patau’s

46
Q

Microcephaly, micrognathia, overlapping fingers with clenched fists, low ears

A

Edwards

47
Q

Flu like symptoms, back ache

Then baby born with rash, HSM and jaundice

A

Most likely cMV

Could be syphilis but also would have
- Hutchinsons teeth
- Saddle nose
- Keratitis (visual problems)

48
Q

Baby is born then gets meningitis, respiratory distress within 1 week of birth

A

Early onset GBS

49
Q

Baby gets meningitis, osteomyelistis and pneumonia from 1 week to 3 months after birth

A

Delayed onset GBS

50
Q

Where do the following come from:

Rhabdomyosarcoma
Leimyosacoma

A

Rhambo - skeletal muscle
Leimyosarcoma - smooth muscle

NEITHER AS EPITHELIAL

51
Q

What causes red degeneration of a fibroid

A

Pooling of blood - leading to swelling. Then becomes ischaemic. Appears red

Hyaline - reduced blood flow - leads to collagen deposition. Appears pale

52
Q

What is the makeup of WBC in %

A

Neutrophils 40-60%
Lymphocytes 20-40%
Monocytes 2-8%
Eiosinophils 1%
Basophils 0.5%

53
Q

what attacks bacteria lipoproteins in cervical secretions

A

Defensins
Cathelicidins

(Also Lysozomes
and IgA)

54
Q

What is the radiation exposure with a VQ scan

A

1 mSv
1 year of background radiation

55
Q

What type of TVS probe used in obese women

A

Lower frequency curviliear probe

56
Q

Sievert vs Gray

A

Gray - absorbed dose Sievert - equivalent dose

57
Q

what is the CTG paper frequency

A

1cm per minute

58
Q

What do the small and large squares on an ECG represent

A

Small - 0.04 seconds

Large - 0.2 seconds

59
Q

What are the normal ECG changes in pregnancy

A

TWI lead 3
Q waves lead 3
LAD

60
Q

Describe the lines on a partogram

A

Latent - horizontal
Active - the sloped lines together
Sloped line on left - alert line
Sloped line in right - action line

61
Q

What do these shapes suggest

A

A - normal
B - OAB
C - voiding issue
D - underactive detrusor with pressure
E - outlet obstruction

62
Q

Normal level of fibrinogen in blood

A

2-4

63
Q

Risk of PET in prim vs multiparous women who didnt have it in first pregnanacy vs women who did

A

Prim - 3-5%

Multip (no previous PET) - 1-2%

Multip (previous PET) - approx 20%

64
Q

MOA neostigmine

A

Anticholinesterase

65
Q

Why can diazepam cross the placenta

A

High lipid solubility

66
Q

What receptors does midazolam effect

A

GABA

67
Q

What in pregnancy can cause decreased drug excretion

A

Decreased albumin and binding proteins

68
Q

Indirect action of Warfarin

A

inhibition of prothrombin 2 (factor 2)

69
Q

What is the most reliable indicator of DIC

A

D-dimer or fibrin degredation products

70
Q

What is the risk of baby developing early onset GBS in this pregnancy if they are GBS positive?

What about the next pregnancy if they are GBS positive or GBS negative?

A

1/800

1/400 if GBS positive again
1/5000 if GBS negative

71
Q

How do you interpret the results of a syphilis screen

A

EIA - antibodies to treponema - DETECTS INFECTION AT SOME POINT. Cannot differentiate. Does not always stay positive for life.

RPR (VDRL) - detect entibodies against cardiolipin which is released by syphilis. Detect ACTIVE INFECTION

TP-PA - antibodies against treponema. Stays positive for life

72
Q

What is the maximum gestation for woman with diet controlled GDM

A

40+6

Needs to be born before 41 weeks

73
Q

Lacy(net like) rash on soles of feel and palms and trunk, Low grade fever and mild joint pain.

slapped cheek appearance on face

A

Parvovirus B19

74
Q

Macular rash starting on the face and spreads to trunk. Not affecting palms and soles.

Lymph nodes raised behind ears

A

Rubella

75
Q

Vesicular rash appearing on trunk and spreading outward and going stages of macule, papule and vesicles

A

VZV
Chickenpox

76
Q

Prodrome of cough, coryzal symptoms and conjunctivitis
Maculopapular rash on face spreadying downwards

Koplik spots

A

Measles

77
Q

Generalised rash including palms and soles but not lacy

A

Syphilis

78
Q

Cocksackie virus rash

A

hand foot and mouth - painful and not lacy

79
Q

What is the most common cause of recurrent miscarriage in terms of uterine malformation

A

Septate uterus

80
Q

Give examples of WHO classification for cardiac maternal risk

A

1:
- Ectopics
- Repaired VSD/ASD
- Uncomlicated vale problem

2:
- Most arrythmias
- Unrepaired ASD/VSD
- Marfans without aortic dilatation
- Rapired ToF

3:
- Marfans with aortic dilatation
- Repaired coartaction
- Fontan Circulation
- HCM
- Mechanical valve

4
- Pulmonary arterial hypertension
- Marfans with severe dilatation
- Severely impaired LV <30%
- Coarctation

MRCOG part 1 (30 decks)

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